Recommendations for reporting and evaluating proton therapy beyond dose and constant relative biological effectiveness
Physics and Imaging in Radiation Oncology, vol. 33, pp. 100692
Abstract
Background and purpose: In proton therapy, a relative biological effectiveness (RBE) of 1.1 is used to convert proton dose into an equivalent photon dose. However, RBE varies with tissue type, fraction dose, and beam quality parameters beyond dose such as linear energy transfer (LET) raising concerns about increased local effectiveness and potential toxicity. This work aims to harmonize quantities used for clinical consideration of variable RBE for proton therapy. Materials and methods: A survey was distributed to proton centres to determine agreement on RBE-related concerns and clinical implementations. A subsequent clinical expert meeting facilitated by the European Particle Therapy Network was held to achieve consensus and to make clinical recommendations how to prescribe and report beyond using dose and constant RBE. Results: The survey was answered by 17 out of 23 centres contacted (74%). For proton RBE, most concerns existed regarding toxicity in serial organs, while the assumption of an RBE of 1.1 was considered valid for targets. Most physicists intended to consider a physical quantity beyond dose in clinical decision making. Conclusions: A constant RBE of 1.1 was the consensus for prescribing dose. However, current practice of recording and reporting dose in proton therapy must be complemented: the recommended quantity beyond dose was the dose-averaged LET in water from primary and secondary protons, normalized to unit density. This will facilitate analyses of treatment data on effectiveness beyond dose and between centres. No consensus on a single variable RBE model was found. More clinical training on proton RBE is needed.
Authors 11
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Armin Lühr corresponding
Affiliation as printed
Department of Physics, TU Dortmund University, Dortmund, Germany
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Maastricht University Medical Centre · Maastro Clinic
Affiliation as printed
Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
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RaySearch Laboratories (Sweden)
Affiliation as printed
RaySearch Laboratories AB, Stockholm, Sweden
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Leiden University Medical Center · Holland Particle Therapy Center
Affiliation as printed
Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
HollandPTC, Delft, the Netherlands
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University Hospital Heidelberg
Affiliation as printed
Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University of Manchester · The Christie Hospital · The Christie NHS Foundation Trust
Affiliation as printed
Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Belgian Nuclear Research Centre
Affiliation as printed
Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
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Affiliation as printed
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
The Skandion Clinic, Uppsala, Sweden
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Affiliation as printed
Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
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